Influenza virus vaccination in children with nephrotic syndrome: insignificant risk of relapse
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ORIGINAL ARTICLE
Influenza virus vaccination in children with nephrotic syndrome: insignificant risk of relapse Shingo Ishimori1,2 · Koichi Kamei1 · Takashi Ando3 · Takahisa Yoshikawa1 · Yuji Kano1 · Hiroko Nagata1 · Ken Saida1 · Mai Sato1 · Masao Ogura1 · Shuichi Ito4 · Kenji Ishikura1,5 Received: 28 September 2019 / Accepted: 8 July 2020 © Japanese Society of Nephrology 2020
Abstract Background Immunization with various vaccines is considered desirable for children with idiopathic nephrotic syndrome (NS) because of their high risk of severe infections. Vaccinations may precipitate relapses of NS, but there is no available data regarding inactivated influenza (flu) virus vaccines. Methods We retrospectively reviewed the medical records of children with NS who had received flu vaccines between 2002 and 2015. The day of flu vaccination was defined as day 0, and the period between the pre-vaccination and the post-vaccination days was defined as − X to + Y. The risk ratios and their 95% confidence intervals for NS relapse rate were estimated by generalized estimating equation (GEE) Poisson regression. Results A total of 104 pediatric patients received 208 flu vaccines. The mean age at onset of NS was at 4.85 ± 3.87 years old. There were 261 NS relapses between days − 180 and + 180. Compared with the relapse rate in the − 180 to 0 interval (1.19 times/person-year), those in 0 to + 30 (1.23), + 31 to + 60 (1.58), + 61 to + 90 (1.41), + 91 to + 120 (1.41), and + 121 to + 180 (1.32) days groups were slightly increased, but without significance. Multivariate analysis using GEE Poisson regression also showed no significant increase in relapse rate in each day group compared with days − 180 to 0. Risk ratios for NS relapse were significantly higher in children who were treated with steroids at the first vaccination. Conclusions Our results suggest that flu vaccines should not be avoided in children with NS based on the potential for NS relapses. Keywords Idiopathic nephrotic syndrome · Relapse · Influenza virus vaccination · Adverse event
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10157-020-01930-8) contains supplementary material, which is available to authorized users. * Kenji Ishikura [email protected]‑mansion.com 1
Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
2
Department of Pediatrics, Takatsuki General Hospital, Osaka, Japan
3
International University of Health and Welfare Hospital, Tochigi, Japan
4
Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokosuka, Japan
5
Department of Pediatrics, Kitasato University School of Medicine, 1‑15‑1 Kitasato, Minami‑ku, Sagamihara, Kanagawa 2520375, Japan
More than half of children with idiopathic nephrotic syndrome (NS) develop frequent relapses or steroid dependence. These children require various immunosuppressants to prevent relapses of NS. Children with NS are therefore exposed to the risk of recurr
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